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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •�q'GrFo*�\P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V S ySi vAVL,-, Date: <br /> Address: `�q JG L YvS W()() S Lv� City: Sioc-17M Zip Code: q C52C�o <br /> Owner/Operator: SSD Telephone: <br /> Program Element: 1 to 2 Program R@COr • M1 o 5 01�7DUU Inspection Type: <br /> SB180 Posted Yes No Permit Posted No Re-Inspection on or After: <br /> ------------........- <br /> �Rt -iS of <br /> d v� A )peicmj . <br /> a <br /> obSgAzyed an open VaC) cr- , "s. acv- GI <br /> G1 <br /> i <br /> t� <br /> J�V <br /> - lfl Ma �- 'In c cjo f�- <br /> r 1{v cSsT- cfv-caEre r <br /> wF <br /> In <br /> Name: C ���� }� 1 ,I- Hand Sink: 1� of hlorine: h ���1 ppm eat; =p <br /> Exp.Date: 1 I I f/ arewashing Sink: -ZU °F Ouat.Amm.: i'� ppm they. -F <br /> Received By/Title: <br /> EH Specialist: Phone: G 6 <br /> Time in: I Time Out: Page f <br /> EHD 7524 (2nO p9) 4PS13 FOOD PROGRAM OIR CONTINUATION <br />